Preventing the Emergence of Antimicrobial Resistance

Abstract

The emerging global problem of antimicrobial resistance has multiple aspects and involves multiple pathogens. One common theme is that antimicrobial drug use exerts selective pressure favoring the emergence of resistance. Strategies to prevent the development and spread of antimicrobial resistance depend on the pathogens. For bacterial respiratory tract pathogens (eg,Streptococcus pneumoniae), controlling outpatient antimicrobial use is crucial^1-3; for some enteric pathogens (eg,Salmonella), limiting antimicrobial use in animals is important^4,5; and, for pathogens that cause nosocomial infections, improving inpatient antimicrobial use and infection control practices is necessary.⁶Addressing antimicrobial use and resistance is one of the most urgent priorities in confronting emerging infectious disease threats.^7,8 See also p 901. Respiratory infections account for more than three quarters of the antimicrobial drug prescriptions written annually in physicians' offices.⁹In this issue ofJAMA, Gonzales et al¹⁰identify antibiotic prescribing for adults with colds, nonspecific